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NEW NARAL PRESIDENT FACES GENERATIONAL CHALLENGE — The selection of Ilyse Hogue as president of NARAL Po-Choice America is an acknowledgement of the challenge that abortion rights leaders are facing — how to “engage a generation that came of age long after the era of the illegal back-alley abortion,” writes Pro’s Kathryn Smith. The fact is younger voters may have a more complex view of abortion rights than those who came of age in the days of Roe v. Wade, which marks its 40th anniversary next week. “This is a critical moment to engage a new generation of young people in the conversation about what choice means in a modern age,” Hogue said in a statement yesterday. Hogue, in her early 40s, replaces Nancy Keenan, 60, who said last year she wanted to step down to make way for younger leaders. The change comes as anti-abortion groups see young people moving more and more toward their side. The Pro story: http://politico.pro/103NQYL

Happy Tuesday and welcome to PULSE, where we learned yesterday nothing quite gets your week started like reading through a brand new 474-page reg. Good times.

“Who’d PULSE rather be: The Beatles or the Rolling Stones?”

TODAY ON POLITICO PRO:

--HHS OFFERS MEDICAID FLEXIBILITY AND DELAY — HHS dropped a sprawling 474-page rule on Monday containing a host of regulations on Medicaid, CHIP and exchanges. Buried inside was a little-noted element that essentially admits that coordinating Medicaid and exchange subsidy eligibility is not going to happen by the time the exchanges open for enrollment this fall. http://politico.pro/10uWalz

--LAWYERS: NOT SO FAST ON ‘MANDATE PLUS’ — Two lawyers who led the legal challenge against the ACA aren’t buying calls from the insurance industry for a tougher individual mandate. Any effort by the Obama administration to more harshly punish those who fail to obtain health insurance would run afoul of the law and may even be unconstitutional, argued Randy Barnett and Michael Carvin. http://politico.pro/UZUWbF

--BREWER BACKS MEDICAID EXPANSION — Arizona Gov. Jan Brewer said yesterday she supports expanding the Medicaid program as long as the federal funding is there to stay. http://politico.pro/Y67RO1

MEDICAID TREND ALERT — Brewer joins Brian Sandoval of Nevada and Susana Martinez of New Mexico as a trio of Republican governors from western states all supporting the Medicaid expansion. Sandoval and Martinez are also moving ahead with state-run exchanges, which Brewer rejected in November.

NORTH DAKOTA GOV ALSO BACKS EXPANSION — He didn’t use a high-profile address to announce his support, but North Dakota Gov. Jack Dalrymple is also backing the Medicaid expansion in his state. The Republican introduced an expansion bill last week in the GOP-dominated Legislature. “Now it’s up to the Legislature to decide if they want to approve the expansion,” Dalrymple’s spokesman Jeff Zent said in an email. The bill: http://1.usa.gov/11vE9Tn

ADVOCATES SEE ACA HOLDING UP MENTAL HEALTH LAW — As we wait for Vice President Joe Biden’s gun task force to issue its recommendations, there have been recent calls for the Obama administration to finally issue complete regs on a 2008 mental health parity law. The way mental health advocates see it, the administration’s focus on implementing the ACA put the Mental Health Parity and Addiction Equity Act on the backburner for years, though advocates think final regs are now “imminent.” Most of the law is in effect, but some key pieces, like defining “scope of services” covered, still need some clarity. http://politi.co/13yi8Tv

** A message from PhRMA: Our new Pinterest “Pinnovation” page tells a story through pictures of how medical innovation partnerships over the last century armed patients against polio, diabetes and cancer. PhRMA’s webinar on Thursday will focus on what the future holds for medicine. **

GAMING OUT THE FISCAL TRIPLE THREAT — Get ready for some fiscal craziness with three critical deadlines all hitting between mid-February and late March: the debt limit, sequestration and expiration of funds to keep the government running. There’s not a whole lot of optimism these showdowns end quickly or painlessly, but there is a whole lot of speculation about how this all goes down. POLITICO’s Carrie Budoff Brown and Jake Sherman map out five ways the debt crisis could play out: http://politico.pro/W4ohjX

E&C PANEL TO REVIEW PROGRAMS — Rep. Tim Murphy announced yesterday his oversight panel will examine a range of mental health programs in light of the Newtown shooting. “The subcommittee will begin an overview of these programs to determine the current state of mental health research and what role mental illness plays in these tragedies,” he said in a statement Monday night.

POLL: BLOCK GUN SALES TO MENTALLY ILL — Four in five Americans don’t think people with mental illnesses should be able to buy guns, according to a Pew Research Center for the People and the Press poll issued yesterday. Republicans were slightly more likely than Democrats to support such a ban (86 percent to 78 percent), while Independents fell neatly in the middle at 82 percent. The poll: http://bit.ly/10uIg2V

DOCS: EASE UP ON MEANINGFUL USE — Doctors are telling the Obama administration’s health IT office to slow down on Stage 3 of the “meaningful use” program for electronic health records. Stressing that the industry is still working out the kinks of the first two stages, the American Medical Association said it’s “extremely concerned” about the program moving too fast without the feds first taking a good, hard look at what’s happening already. “[W]e believe that it is a serious mistake to keep adding stages and requirements to the meaningful use program without evaluating Stage 1 of the program,” the AMA wrote in formal comments to the Office of the National Coordinator for Health IT. The letter: http://bit.ly/13vyGKW

— HOSPITALS: DITTO — The Federation of American Hospitals also said ONC should take stock of current meaningful use requirements before providers sink serious dough into preparing for the program’s third stage. They’re also worried that the quick progression in meaningful use stages doesn’t give providers enough time to actually evaluate the data they’re getting from the electronic systems. “We believe the current regulatory construct of two years in each stage is a barrier to fully realizing the core goals of the Meaningful Use Program — to improve the quality, safety and efficiency of health care provided to patients,” FAH wrote. Its letter: http://bit.ly/WH2376

GEITHNER: ACT EARLY ON DEBT CEILING — The government will exhaust its borrowing authority between mid-February and early March if Congress doesn’t raise the debt ceiling, outgoing Treasury Secretary Timothy Geithner wrote to lawmakers yesterday. Tax season makes it hard to actually predict when the debt ceiling will be hit, so for that reason, Congress should get it done “as early as possible.” The GOP wants dollar-for-dollar spending cuts, and Obama says they’re not getting anything. So, good luck with the whole not-waiting-until-the-last-minute thing. The Pro story: http://politico.pro/W1oWUd

PAUL RYAN STILL WANTS TO REPLACE OBAMACARE — Just because the campaign is over, you didn’t think that Mitt Romney’s running mate was going to give up on replacing Obamacare, did you? Ryan, making his first Wisconsin appearance since missing out on the vice presidency, argued for repeal and replace, predicting employers will dump workers into exchanges and make the ACA unsustainable. “We know we can’t beat something with nothing, so we plan on going into great legislative detail about Obamacare replacement, reforming the income tax code and dealing with our entitlement problem,” the House Budget chairman said at a tea party event this weekend, according to a local report posted to Ryan’s website: http://1.usa.gov/VWynq9

HAPPENING TODAY — The Medicaid and CHIP Payment and Access Commission kicks off a two-day meeting. The agenda: http://1.usa.gov/U4bTSi ... AARP CEO Barry Rand speaks about strengthening the middle class at the National Press Club this morning.

WHAT WE’RE READING

In an interview with USA Today, Papa John’s CEO John Schnatter said his widely circulated comments on Obamacare last year were “misconstrued” — and that they’ve had no effect on the company’s revenues or stock price. http://usat.ly/W4qSLe

Amid the influenza outbreak, hospitals in some states are asking visitors with flulike symptoms to stay away, The New York Times reports. http://nyti.ms/Y65EC8

Wal-Mart is looking into possibly starting a private health insurance exchange for small businesses, the Orlando Business Journal reports. http://bit.ly/10nvQtu

UnitedHealth Group and the Mayo Clinic are teaming up on research involving millions of health insurance claims and clinical records, The Wall Street Journal reports. http://on.wsj.com/V6viG8

A panel appointed by Chicago Mayor Rahm Emanuel has suggested the city should drop subsidized insurance for retired workers and let them seek ACA coverage, the Chicago Tribune reports. http://trib.in/Umrlcx

Two California health care administrators were sentenced on Monday for their roles in a $154 million fraud scheme in which healthy patients were recruited to undergo unnecessary surgeries, the L.A. Times reports. http://lat.ms/Xztan7

** A message from PhRMA: When Warren Harding was sworn into office in early 1921, millions of diabetic patients had no treatment options. Later that year, insulin was discovered. Mass production of insulin started in 1923, providing millions of diabetes patients with access to the first treatment to control their disease, ultimately saving their lives. Although diabetes is among the most common chronic conditions in the United States today, control of the disease is possible through diet, exercise and patient adherence to their prescription drug regimen. A recent study projected that improved adherence to diabetes medication could save $4.7 billion in reduced ER visits and hospitalizations, showing that medicines can provide cost savings in addition to better health outcomes. For more information, go to www.FromHopetoCures.org. **